PLEASE READ CAREFULLY

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1 Business Licensing Services Bureau P.O. Box 170 Trenton, New Jersey (609) ext.5014 E-M ail: PLEASE READ CAREFULLY Enclosed are the application and supplemental forms necessary to apply for an auto body repair facility initial license. If you are engaged in the business of performing auto-body repair and/or auto-body painting services you must be licensed. If you commence auto-body work without a license, you will be in violation of New Jersey Auto-Body Repair Facility Act, N.J.S.A. 39:13-1 et seq., which states, person may engage in the business of an auto-body repair facility unless it is so licensed by the Commission. Pursuant to N.J.S.A. 39:13-6, the Chief Administrator of the New Jersey Motor vehicle Commission has the power and authority to issue an order to cease and desist from operating an auto-body repair facility without a license to do so. The Chief administrator may also impose upon an auto-body repair facility operating without a license a civil penalty of up to $ for the first offense and up to $20, for the second and each subsequence offense. In accordance with recently adopted regulations, each applicant for an auto-body license shall have and established place of business at the time such license is issued. An established place of business must have an exterior sign, a suitable office and be in conformance with the requirements of the municipality in which it is located. It is imperative that the municipal or zoning board clerk complete the enclosed approval certificate form. However, we will accept a photocopy of a certificate of occupancy in lieu of the completed approval certificate. Insurance coverage requirements for damage to property and liability arising from bodily injury: (a) Garage liability or equivalent commercial general liability insurance in the minimum amount of $300,000 or a letter of credit in the amount of $300,000; and (b) Garage keepers liability insurance in a minimum amount of $50,000 or a letter of credit in the amount of $50,000; and (c) Workers Compensation insurance or a statement advising no employees. The fee for the license is $ plus an additional non-refundable application fee of $ Please return the completed application to this office with all required documents. If you have any questions, please call (609) ext or us at mvcblsprocessing@mvc.nj.gov. BLC-25 (R 5/16a) On the Road to Excellence Visit us atwww.njrnvc.gov New Jersey is an Equal Opportunity Employer

2 AUTO-BODY INITIAL APPLICATION CHECKLIST In order to ensure prompt processing of your Auto-Body Application, please submit all documents listed below: 1. License fee ($350.00). n-refundable processing fee ($20.00). Certified checks/money order payable to the NJMVC. 2. License application and municipal approval. 3. Supplemental application for each owner, partner(s), officer(s) or member(s). 4. Child support certification for each owner, partner(s), officer(s) or member(s). 5. Fingerprint request notification form. 6. Copy of driver license for each applicant. 7. Color photograph of each applicant. 8. Copy of your Corporate Certificate (Inc.) or formation papers for LLC, Partnerships and sole Proprietors. 9. Copy of property deed or lease. 10. Business Hours Form (Enclosed). 11. Federal Tax Identification Number. (Attach copy of certificate). 12. NJ Sales Tax Identification Number. (Attach copy of certificate). 13. Workers compensation insurance or a statement advising no employees. Please note that if employees are hired after the license has been issued, you must submit workers compensation insurance at that time. 14. Insurance coverage requirements for damage to property and for liability arising from bodily injury (both Full Service and Limited Full Service applicants): a. Garage liability or equivalent commercial general liability insurance in a minimum amount of $300,000 or a letter of credit in the amount of $300,000; and b. Garage keepers liability insurance in a minimum amount of $50,000 or a letter of credit in the amount of $50,000 Certificate holder must read: NJ Motor Vehicle Commission Auto Body Unit, PO Box 172, Trenton, NJ List of authorized signatories (Those authorized to sign Motor vehicle documents). 16. Statement advising if your facility will be performing painting services. 17. Photographs of the auto body repair facility showing signs and other advertising media. 18. Current certificate of inspection from the fire marshal for the building and spray booth. 19. Evidence of completion from a recognized auto body class; at least one class must be taken within one (1) year preceding issuance of the initial license. 20. Stack permit or letter of exemption from DEP for spray booth. 21. Provide signed agreement (sample enclosed) if the below listed services will be performed by a facility other than yourself: ( ) structural repairs ( ) vehicle four-wheel alignment ( ) air conditioner servicing ( ) mechanical repair as a result of collision damage. 22. If your auto body repair facility will not be spray painting, please contact this office for additional forms. Prior to your Auto Body Repair Facility license being issued, a site inspection will be conducted. An investigator from the Commission will contact you. BLC-25 (R 6/16)

3 New Jersey Motor Vehicle Commission Business Licensing Services Bureau P.O. Box 170, Trenton, NJ ext APPLICATION FOR LICENSE FOR OFFICE USE ONLY License. Reg.. Approved by Date The undersigned hereby applies for the license(s) checked in Part 3 and submits the following certified statement: Corp Code 1. Name of Business (if corporation, corporate name) Business phone Trade Name Street Address 2. Please Check Corporation Partnership Proprietorship Other City Zip Code County 3. Please Check appropriate Box for License: All applicants please provide the following information and attach copies of proof thereof: A. NJ Sales Tax Identification Number B. NJ Unemployment Registration Number C. Federal Employer Identification Number 4. Complete the following for proprietor, partners, or corporate officers: Leasing Company Driving School Moped Dealer Private Inspection Facility Fleet Inspection Facility Other New & Used Motor Vehicle Dealer Auto Body Repair Facility Used Motor Vehicle Dealer Name Title Home Address Telephone Number 5. Have the owners, partners, or officers ever been arrested, charged or convicted of a criminal or disorderly persons offense in this or any other state? if yes, explain: 6 Do you knowingly intend to employ a person who has been convicted of the above, or any other crime or who was previously licensed as any Of the above in this or any other state and was subject to license suspension or revocation? Give name and address of person

4 7 Have the owners, partners or corporate officers ever held any of the above licenses? If yes, please explain the type of license and license numbers 8. Was the license ever suspended or revoked? If yes, explain: 9. Have the owners, partners or corporate officers, agents or employees of your organization ever used an alias or been known by any other name If yes, explain: 10. Does any stockholder own more than 10% of the corporation's stock? If yes, give name, address and holding 11 Place of Incorporation/Formation Date of Incorporation/Formation Date of authorization to do business in New Jersey Attach copy of the Certificate of Incorporation/Formation which has been filed with the N.J. Secretary of State. Foreign Corporations must submit a copy of their Authorization to do business in New Jersey as a Foreign Corporation in addition to a copy of their corporate/formation papers. 12. The applicant certifies all information contained herein is true and agrees any untruthful representation and any violation of the applicable statutes and regulations promulgated by the Commission shall be reasonable and proper grounds for license suspension or revocation. He further agrees to notify the Commission immediately of any change in the status of the business or of any other information which would change the answers and statements in this application or supplement thereto 13. The individual(s) signing this application certify that they have read the applicable statutes and are thoroughly familiar with the details and penalties provided. I, the undersigned, hereby certify that I of the above business previously named Owner, Partner, Officer, Member and that the information I have submitted is true to the best of my knowledge. Print Name of Applicant Signature and Title of Applicant the undersigned, hereby certify that I am Secretary/Member/Partner of the above Corporation and have witnessed the signature of who is of said corporation. President, Vice-President or Member Signature of Secretary/Member/Partner BLS-183 (R 12/15)

5 Applicant Information MOTOR VEHICLE COMMISSION BUSINESS LICENSING SERVICES BUREAU P.O. BOX 172 TRENTON, NEW JERSEY MUNICIPAL APPROVAL CERTIFICATE FOR BUSINESS LICENSE Applicant Name: Title Business Name: Business Phone: Street Address (include suite #) City Zip Approval Classification of Applicant A. Please check appropriate box: B. Please check appropriate type of license: Initial Boat Dealer Leasing Company Change of Address Driving School Moped Dealer Branch Location Used Motor Vehicle Dealer PIF/PIM Existing Facility Zoning Compliance Municipal Zoning Official Certification New & Used Motor Vehicle Dealer (Please specify type of vehicle) Auto Body Facility (Check all that apply) Full Service Auto Body Limited Full Service Auto Body Sublet Auto Body (new car dealer) Heavy Duty Vehicle Endorsement I,, Clerk of the Municipality of, County of, State of New Jersey, hereby certify that the Municipal Governing Body or Zoning Commission has approved the location, establishment and maintenance of the above indicated business located at:. (Complete Address) Please check appropriate box: Site was visited by a Zoning Official/ Municipal Representative prior to approval Site was not visited by a Zoning Official/ Municipal Representative prior to approval Please specify any stipulations of your zoning approval: Municipal Seal Signature of Municipal or Zoning Board Clerk Date Print Name Contact Number

6 BUSINESS LICENSING SERVICES BUREAU SUPPLEMENTARY APPLICATION PLEASE PRINT BUSINESS NAME BUSINESS PHONE NUMBER 1. FULL NAME (Including Middle and Suffix, if any) 2. STREET ADDRESS 3. CITY 4. STATE 5. ZIP CODE 6. COUNTY 7. HOW LONG HAVE YOU LIVED AT THE ABOVE ADRESS? 8. HOME PHONE NUMBER 9. LIST THE CITIES, STATES OR FOREIGN COUNTRIES WHERE YOU HAVE LIVED, AND HOW LONG YOU LIVED IN EACH. 10. DATE OF BIRTH (MONTH, DAY, YEAR) 11. PLACE OF BIRTH (CITY, STATE OR FOREIGN COUNTRY) 12. SEX 13. HEIGHT 14. WEIGHT 15. COLOR OF EYES 16. SOCIAL SECURITY NUMBER* 17. DRIVER LICENSE NUMBER *You must disclose your social security number to the NJMVC. Failure to do so may result in denial/non-renewal of licensure. Pursuant to N.J.S.A. 54:50-25 et seq. of the New Jersey taxation law, N.J.S.A. 2A: a, and N.J.S.A. 2A: et seq. of the New Jersey Child Support Program Improvement Act; the licensing agency to which this form is submitted is required to obtain your social security number. Pursuant to these authorities, the licensing agency is also obligated to provide your social security number to: a. the Director of Taxation to assist in the administration and enforcement of any tax law, including for the purpose of reviewing compliance with State tax law, updating, and correcting tax records; and b. the Probation Division or any other agency responsible for child support enforcement, upon request 18. HAVE YOU EVER BEEN CONVICTED OF A CRIME, DISORDERLY PERSONS OFFENSE AND/OR VIOLATION OF CONSUMER PROTECTION LAWS OR REGULATIONS? NO YES IF YES, ATTACH EXPLANATION DESCRIBING NATURE OF OFFENSE, DATE, CITY AND STATE WHERE OFFENSE OCCURRED, IDENTIFY COURT OR ADMINISTRATIVE TRIBUNAL BEFORE THE CASE TRIED, DATE AND SENTENCE I CERTIFY THAT THE INFORMATION PROVIDED HEREIN AND ATTACHMENTS, IF ANY, ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SIGNATURE: DATE: BLC-205B (R10/12)

7 P.O. Box 168 Trenton, New Jersey (609) #5014 Business Licensing Services Bureau CHILD SUPPORT CERTIFICATION FORM Business Name Applicant s Name (Print) Date of Birth Social Security Number *You must disclose your social security number to the NJMVC. Failure to do so may result in denial/non-renewal of licensure. Pursuant to N.J.S.A. 54:50-25 et seq. of the New Jersey taxation law and N.J.S.A. 2A: a, N.J.S.A. 2A : et seq. of New Jersey Child Support Program Improvement Act, the licensing agency to which this form is submitted is required to obtain your Social Security number. Pursuant to these authorities, the licensing agency is also obligated to provide your Social Security number to: a. the Director of Taxation to assist in the administration and enforcement of any tax law, including for the purpose of reviewing compliance with State tax law, updating, and correcting tax records; and b. the Probation Division or any other agency responsible for child support enforcement, upon request. Under the provisions of N.J.S.A. 2A: et seq., responses to the questions listed below are required. Intentional misstatements may result in administrative action including, but not limited to, denial of licensure, immediate suspension or revocation of the license. 1. Do you have a child support obligation? 2. If yes, do the arrearage amounts equal or exceed the amount of child support payable for six months? 3. Are you subject to a child-support warrant? I certify that the foregoing responses made by me are true and I am aware that the making of false statements may subject me to contempt of court. Signature Date On the Road to Excellence New Jersey is an Equal Opportunity Employer BLS-43 (R10/12)

8 New Jersey Motor Vehicle Commission Trenton, New Jersey Business Licensing Services Bureau PO Box 168 (609) ext.5014 I,,owner of (Subcontractor) located at hereby certify that I have entered into an agreement with located (Autobody Licensee) at to perform the below listed service: [ ] Four-Wheel Alignment [ ] Air Conditioner Servicing [ ] Mechanical Repairs [ ] Structural Repairs (Frame Machine) [ ] All of the above services are preformed in house I understand that this document will be attached to his/her New Jersey Full Service Auto Body Repair Facility License. Signature Subcontractor Signature Licensee Date

9 New Jersey Department of Environmental Protection Office of Local Environmental Management Minor Source Compliance Investigations P.O. Box 407 Trenton, NJ To Whom It May Concern: I have been informed that an air pollution permit is no longer required by the Department as established in N.J.A.C. 7:27-8.2(a) (Eleventh Amendment operative June 12, 1998) since my coating application will NEVER EXCEED ½ GALLON PER HOUR AND MY Spray booth DOES NOT contain a heating device with a rating of 1,000,000 BTU s or greater. As such, I am requesting deletion of the following surface coating permit(s) /certificat(s) and hereby certify under penalty of law that I believe the information provided in this document is true, accurate, and complete. I understand that if at any time our coating rate does exceed the applicability threshold of ½ gallon in any one hour or the heating device does equal or exceeds 1 million BTU s, it is my responsibility to apply for the necessary permit(s) and certificate(s). I further understand that if I exceed these thresholds and fail to apply for the necessary permit(s) and certificate(s) I may be subject to an enforcement action which may include civil and criminal penalties, including the possibility of fine or imprisonment or both, for submitting false, inaccurate or incomplete information. Signature: Title: Name of Facility: Address: Phone#: Program Interest ID#: Activity Number ID#: Date:

10 Motor Vehicle PO Box 172 Commission Trenton, New Jersey SIGNATURE CARD Business Type: MV Dealer Autobody Repair The undersigned Licensee hereby authorizes the person(s) whose signatures appear below to execute and sign Title Papers and/or estimates on behalf of the licensee: (AGENT'S NAME - PRINT IN FULL) (SIGNATURE) (ADDRESS) (AGENT'S NAME - PRINT IN FULL) (SIGNATURE) (ADDRESS) (AGENT'S NAME - PRINT IN FULL) (SIGNATURE) (ADDRESS) (AGENT'S NAME - PRINT IN FULL) (SIGNATURE) (ADDRESS) (AGENT'S NAME - PRINT IN FULL) (SIGNATURE) (ADDRESS) BUSINESS NAME & LICENSE NO. (Print in full) LICENSEE'S SIGNATURE (OWNER, PARTNER OR CORPORATE OFFICER) DATE Signature card or cards must be filed for all persons authorized to sign title papers and/or estimates. If you authorize any other person to sign title papers and/or estimates or if you revoke the authority of any person to sign such papers, you shall notify this Bureau immediately and re-submit current signature card or cards, covering all persons in authority to sign title papers and/or estimates. All signature cards prior to the most current are invalid. BLC-9 (R12/04)

11 New Jersey Motor Vehicle Commission Business Licensing Services Bureau P.O. Box 172, Trenton, NJ ext Fingerprint Request tification In accordance to regulatory requirements, it is mandated that all persons identified in the initial business application (proprietors, partners, corporate officers, applicants, providers, instructors and driving school authorized agents) undergo a live scan criminal background check by the state approved vendor. Submission of your initial business application authorizes the Commission s Business Licensing Bureau to request and receive criminal background check results. Upon receipt of this notification, each person identified will be mailed a fingerprint application and instructional sheet. Once fingerprinted, the receipt and fingerprint application for each person listed must be forwarded to MVC, as proof of completion. The processing of your business application will not begin until all receipts are received. Complete the attached Fingerprint Request tification Form listing each person identified in the business application. If an address is provided, the documents will be ed to those individuals, otherwise it will be mailed.

12 New Jersey Motor Vehicle Commission Business Licensing Services Bureau P.O. Box 172, Trenton, NJ ext Fingerprint Request tification Form Business Name: Date: Clearly PRINT the following information for all persons identified in the initial business application ( all proprietors, partners, corporate officers, applicants, providers, instructors and driving school authorized agents) Applicant Full Name: Street Address: City: State: Zip: Phone Number: Address: Applicant Full Name: Street Address: City: State: Zip: Phone Number: Address: Applicant Full Name: Street Address: City: State: Zip: Phone Number: Address: Copy and submit additional sheets if needed

13 New Jersey Motor Vehicle Commission Office of Regulatory Affairs Business License Services P.O. Box 170 Trenton, New Jersey BUSINESS HOURS Name of Business License. Address Days Open for Business Business Hours Monday From To Tuesday From To Wednesday From To Thursday From To Friday From To Saturday From To Signature of Proprietor, partner or officer Date MM BLC-86A (R12/03)